De novo thrombotic microangiopathy following treatment with sirolimus: report of two cases

Crew, R. John; Radhakrishnan, Jai; Cohen, David J.; Stern, Leonard; Goldstein, Michael; Hardy, Mark A.; D’Agati, Vivette D.; Markowitz, Glen S.

doi:10.1093/ndt/gfh334

Cited by 45 publications

(33 citation statements)

References 25 publications

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“…Only few patients start transplantation on a calcineurin inhibitor-free sirolimus-based protocol. Nevertheless, two preliminary reports suggested that sirolimus in the absence of calcineurin inhibitors may induce TMA in renal transplants (11,12). We report 4 cases of TMA on calcineurin inhibitor-free sirolimus-based protocols.…”

Section: Discussionmentioning

confidence: 78%

“…Few patients start transplantation on a calcineurin inhibitor-free sirolimus-based protocol because phase II trials have shown that the lowest acute rejection rates can be obtained by combining sirolimus with ciclosporin. However, two preliminary reports suggested that sirolimus in absence of calcineurin inhibitors may induce TMA in renal transplants (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Sirolimus‐Induced Thrombotic Microangiopathy is Associated with Decreased Expression of Vascular Endothelial Growth Factor in Kidneys

Sartelet¹,

Toupance

Lee³

et al. 2005

American Journal of Transplantation

133

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The aim of this study was to examine the clinical characteristics, the histological features and the renal expression of vascular endothelial growth factor (VEGF) of five patients with sirolimus-associated thrombotic microangiopathy (TMA). Sirolimus-induced TMA occurs preferentially in kidneys with concomitant endothelial injury: it was observed in three patients with acute cellular rejection on calcineurin inhibitor-free regimen, in one patient with chronic graft rejection on a calcineurin inhibitor-free protocol and in one patient with chronic calcineurin inhibitor nephrotoxicity. We found that renal VEGF expression during sirolimusinduced TMA was significantly lower than VEGF expression in normal transplanted kidneys (p < 0.01). Decreased expression of VEGF seems to be a consequence of sirolimus treatment since (i) analysis of two biopsies performed after the switch of sirolimus to calcineurin inhibitor showed reappearance of VEGF expression, (ii) no decreased expression of VEGF was found in five kidneys with classical TMA and, (iii) an increased expression of VEGF was observed in seven kidneys with acute cellular rejection on a sirolimus-free immunosuppressive regimen (p < 0.01). The potential role of sirolimus-induced downregulation of VEGF as a predisposing factor to the development of TMA is discussed.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Sirolimus‐Induced Thrombotic Microangiopathy is Associated with Decreased Expression of Vascular Endothelial Growth Factor in Kidneys

Sartelet¹,

Toupance

Lee³

et al. 2005

American Journal of Transplantation

133

View full text Add to dashboard Cite

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“…Several studies have shown the risk of TA-TMA to be remarkably higher when a combination of an mTORi and a CNI is used, with many reports originating from series of lung transplant recipients [14,55,[79][80][81].…”

Section: Mtor Inhibitorsmentioning

confidence: 99%

De novo thrombotic microangiopathy after non-renal solid organ transplantation

2014

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“…Our patient's medications included sirolimus. Like cyclosporine and tacrolimus, the mammalian target of rapamycin inhibitors sirolimus and everolimus have been implicated in causing thrombotic microangiopathy (TMA) (31)(32)(33). Our patient's sirolimus level was elevated at 17.1 ng/ml.…”

Section: Discussion Of Case 2 Question 2bmentioning

confidence: 80%

American Society of Nephrology Quiz and Questionnaire 2013

Josephson

Perazella

Choi

2014

Clinical Journal of the American Society of Nephrology

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The nephrology quiz and questionnaire remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories along with single best answer questions were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the nephrology quiz and questionnaire was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of caseoriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responds, and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for the readers of CJASN. Enjoy the clinical cases and expert discussions.

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De novo thrombotic microangiopathy following treatment with sirolimus: report of two cases

Cited by 45 publications

References 25 publications

Sirolimus‐Induced Thrombotic Microangiopathy is Associated with Decreased Expression of Vascular Endothelial Growth Factor in Kidneys

Sirolimus‐Induced Thrombotic Microangiopathy is Associated with Decreased Expression of Vascular Endothelial Growth Factor in Kidneys

De novo thrombotic microangiopathy after non-renal solid organ transplantation

American Society of Nephrology Quiz and Questionnaire 2013

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